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FUR OFFICE USE: --------------------------------------------------------- `Q -.--_.-----.-.._--_-.-_------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. . __ ------------------------- ----------------------------_ (Complete in Duplicate) bats Issued .. /..'.�/6- ---------------------------------------------------------- This Permit Expires i Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. cis' QZ�—Q�Q-0'7 '. �^- .....-. .. JOB ADDRESS ANDj tOCATI �ON _ _� ____l -_ .._._____ Owner's Name-----Rl/� = f" .�#r._cx -ti------------------------------------ Address............................................................•....... - -----------------..---------------------------------- - ---- -----•--- -------------------•------------ Contractor's Name ��--------- '"= " -----------------r+ c •- C"r •-- o-- ••......•...---•--.........-_.. Installation will serve: Residence,( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I..... Number of bedrooms _.T- Number of baths3j&&Lot size 31a-'*-, ,4...................•.......-_ Water Supply: Public system ❑ Community system,❑ Private 20 Depth to Water Table Yd ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Ve Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date:--------------_---1 No New Construction; Yes No ❑ FHA/VA: Yes ❑ No ❑ _ . � . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SFptic Tank: Distance from nearest well---sP.1-.-Distanc from foundation-_-_ZQ!--------Material_& A'e!�4....................•..... I No. of compartments--A'-_-----._: �flite, /: t '- ^Liquid depth------#-.-----__-----Capacity_.Z.,�-_ .._.. f Disposal Field: Distance from neare t well., "a'-___.Distance from,foundation->iD............Distance to nearest lot�line...r......... Number of lines_-__---------- Length of each lineFQ__ -----IS77---Width of trenchx%.Y_-�k -- ......... Type of filter mate ria RQepth of flter',material--Y?_'--___-----.Total length-_-- ----------------------------------- _ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot ....... ❑ Number of pits-_------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: - Distance from nearest well-----------------Distance from foundation--------------------Lining material..-_-.-_----_--------_-_------------• ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. Priv Distance from nearest well----------------------------- ----Distance from nearest building ❑ Distance to nearest lot line--------------------------------------------------------------------- ------•-••-----•-------------------- ....... Remodelingand/or repairing (describe)----------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- I ---•------------------•------•----------------•-------•----- ------------.-----------•-•----------------------------------------------------------------------------------------...._...--•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)..-• - (Owner and/or Contractor) By:._... --------------------------------------------------(Tif10)------------- -• - ` (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- -----------------0 ------ DATE----------- -- ---------`-�--------------------- REVIEWEDBY----------------------------------------------------------------- ---------------------- --------------------.------------ DATE-------------------•-•--------•--------------------------- BUILDING PERMIT ISSUED--------------- ------------------- D'T .. --- Alterations and/or recommendations:-..- � .X- _-- _____ ..--•--- ---- -- - -------•' ----------- ......------------- ---.--•- d � --r W&1�:---- 1-2a`.. ................................. --1....................... --------------------- -----• -------•----....-••-----------....---------------------------------- . ..- ------ ---------- �- ---- ---------------------------------------------•---------------------------------------- FINAL INSPECTION BY: ----- - ------------- -------- Date_/� -/0 l r� SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 RM 5-61 ATLAS